Includes whereas clauses.

Appropriates $134 million in recurring funds for 2025-26 and $357,340 in recurring funds for 2026-27 from the General Fund to the Department of Health and Human Services, Division of Health Benefits (DHB), to increase the number of North Carolina Innovation Waiver slots, as required by this act. Specifies that these funds are for a state match.

Requires DHB to amend the North Carolina Innovations Waiver to increase the number of waiver slots available under the waiver for 2025-26 year by 5,000; sets out how these waiver slots are to be distributed and requires that they be made available October 1, 2025, unless the method of acceptance or rejection of waiver slots requires approval by the Centers for Medicare and Medicaid Services (CMS). Provides that if CMS approval is required, then any waiver slots that are rejected under the act’s procedure must be made available upon the later of October 1, 2025, or the date that CMS grants or denies approval of the rejection and acceptance procedure. Provides that if CMS approval is required and CMS does not approve the rejection and acceptance procedure, then any rejected waiver slots remain distributed using the allocation formula currently in place as of the act’s effective date.

Requires DHB to distribute the 5,000 waiver slots using the allocation formula currently in place as of the effective date of this act, so long as the slots are filled on a first-come, first-served basis based on how long an individual has been on the waiting list. Requires each LME/MCO to elect, within 30 days of receiving the offer of the waiver slot, whether any of the slots. Requires any waiver slots that are not accepted by an LME/MCO to be distributed equally among the LME/MCOs that attest that: (1) the LME/MCO ensures that all rates paid to providers for any services provided to beneficiaries receiving those services through the Innovations Waiver are sufficient to pay its direct care employees a minimum wage of $20/hour; and (2) the ability and capacity to provide services to the beneficiaries that will receive the additional waiver slots exists within the LME/MCO's catchment area.

Requires DHB to amend the North Carolina Innovations Waiver to increase the number of waiver slots available under the waiver for the 2026-27 fiscal year by 5,000. Requires the slots to be distributed using the allocation formula currently in place as of the effective date of this act; provided all waiver slots are filled on a first-come, first-served basis determined by the length of time an individual has been on the waiting list. Requires these waiver slots to be made available July 1, 2026.

Effective July 1, 2025.